More than Genetics: Social Determinants of Health
Hypothetically, let’s claim that not all patients receiving health care are treated equally. I know, as a pre-health student, this claim is outrageous because the medical field must be full of the perfection, rainbows, and butterflies I imagined when I first wanted to become a physician. How is it conceivable that the infant mortality rate of Native American and Alaskan Natives is 60% higher than that of the white population? Or that African American men are 30% more likely than white American men to die prematurely from cardiovascular disease? Even that minority women are less likely to avoid seeing a doctor due to cost? As much as I hate to pop the bubble that is our fantasies about medicine, racial and ethnic disparities are very real problems that the healthcare industry faces and that must be addressed to achieve equitable treatment.
According to the CDC, a large aspect of health is accredited to social determinants, which are the economic and social conditions that influence the health of communities and people. Examples of social determinants include early childhood development, quality of education, job security, food security, access and quality of health services, adequate housing, social support, language and literacy, incarceration, access to technology, and many more. Many of these factors have inherent racial implications through the history of structural and institutionalized racism within the United States; one such example of historical influence were the Jim Crow laws from the early 19th century that established barriers toward job security, housing, and equitable education. What this means is that many of the statistical disparities we see are not necessarily genetically tied to different races, but rather are the cumulative effects of sociopolitical inequalities.
Even more concerning are the racial and ethnic health disparities that relate to the psychological stressors of experiencing racial discrimination. Namely, ‘mixed race’ children with a Black mother and a White father have higher rates of low birth weight than children with a White mother and a Black father (Tashiro, 2020). This outcome is attributed to the psychosocial stressors of racism that Black mothers experience and pass down through epigenetics, the study of changes in gene expression through environmental exposures. There are numerous ways in which racial/ethnic minorities experience racism--these include systemic and institutionalized racism as well as direct, face-to-face discrimination such as racial slurs, unfair treatment, and violence. Exposure to racial discrimination has been proven to be associated with poor physical health, substance abuse, and mental illness (Tashiro, 2020), and there are a variety of health issues related to direct experiences with racism. Some of these include elevated blood pressure, abdominal obesity, breast cancer, heart disease, premature death, increased anxiety and depressive symptoms, and elevated stress hormones in teenagers (Tashiro, 2020). It is also important to note that although there is no biological basis for race, the impacts of racism in healthcare are apparent and serve to emphasize the importance of continuing to acknowledge and mitigate health inequities. Without these conversations, how do we ethically contribute to and work towards a system that disproportionately disadvantages entire communities?
Ultimately, as many of us continue on in our education in health care, it is important that we address the social factors that have led to the inequities we see in the medical field today. As much as O-Chem and genetics are valuable knowledge for pre-health students to master, we can’t leave behind the important social factors that shape how patients experience and perceive health.
As much as I would love to stay in the bubble of my childhood fantasies about medicine, the reality of these ingrained problems serves as a reminder to all of us of the work that needs be done to create a system of accessible and quality health care for all people regardless of their race, ethnicity, or socioeconomic status.
Crowley, Ryan. “Racial and Ethnic Disparities in Health Care.” Racial and Ethnic Disparities in
Health Care, Updated 2010, American College of Physicians, 2010,
“Frequently Asked Questions.” Centers for Disease Control and Prevention, Centers for Disease
Control and Prevention, 19 Dec. 2019, www.cdc.gov/nchhstp/socialdeterminants/faq.html.
Sciences, National Academies of, et al. “The State of Health Disparities in the United States.”
Communities in Action: Pathways to Health Equity., U.S. National Library of Medicine,
11 Jan. 2017, www.ncbi.nlm.nih.gov/books/NBK425844/.
Tashiro, Cathy J. “Race, Racism, Ancestry and Health: Implications for Mixed Race People.”
Global "Mixed Race" Studies. 15 Sept. 2020.